6 replies to this topic

[returnable]

Due to advanced maternal age, I have DOR. In our first IVF we did the estrogen priming antagonist protocol. I ended up growing three follicles and had two eggs. We came out with one beautiful blastocyst, but unfortunately it was chromosomally abnormal.

 

For our next, and last, IVF, I will be doing the microflare protocol. The month before I will be doing OCP/cetrotide. When does the OCP/cetrotide start, and for how long is it taken? Also what are the doses of cetrotide when it is used in priming protocol? I am concerned that the OCP will over-suppress. What is the thought behind this pre-treatment? Does the cetrotide balance out the suppressive effects of OCP?

[jtstan]

Hi Returnable,

 

I have done the microflare protocol twice, and also have DOR.  It does seem to me that both the pill and an antagonist seems like overkill as far a suppression is concerned.  I would think that the pill would be sufficient to quiet the ovaries...not sure why they would also want to add an antagonist in as well.  I did the microflare protocol both times using estrogen priming.  The first time I used Estrace pills 4mg/day, 7 days after ovulation and I found even with that my response was blunted.  I did better the second time using Estrogen patches also started 7 days after ovulation and changed every other day... I feel I did better with that as with the Estrace pills my blood estrogen level was still a bit high when starting stims, but the patches provided a lower more sustained dose of Estrogen and I was able to start stims with my estrogen at a nice appropriate low level.  Not sure this helps but thought I'd share my experience!

[DrMichaelHartman]

This is a common pre-treatment protocol for DOR. The OCP and cetrotide provide different mechanisms of action in preparation for stimulation, but the goal is to lower FSH levels for the start of stimulation and to prevent the early recruitment of follicles prior to starting stimulation. There is always the chance of suppression with any pretreatment but in most cases it is not a major issue, and I assume your RE would have good reason to go with that preteatment. 

[returnable]

Thanks Dr Hartman. I do have trust in my RE it is just a challenge to change protocols. I'm glad to know this is a common method for DOR. It seems the antagonist protocol seems more common these days however.

[DrMichaelHartman]

I would say that 80-90% of the cycles at our clinic are antagonist cycles, as they are probably the most flexible and safest for high responders. However the flare protocol has historically been used for DOR and "poor responders." Although some studies have shown that the antagonist protocol is equally effective with DOR, a physician will often switch protocols if the first cycle is not successsful. Given that you did not have the desired results with an antagonist protocol, many RE's would change protocols to try to improve the response or change the outcome.

 

Good luck with everything!

[returnable]

Thanks Dr. Hartman. One last clarification on this protocol. It seems that with the microflare protocol, it is standard to do an endometrial biopsy during the pre-treatment month. What time in the cycle is this done? What is the purpose of this biopsy? Are there decision points to proceed or not proceed with the cycle based on the test results?

 

I understand the benefits to implantation that an endometrial scratch has the month before an IVF cycle assuming a fresh transfer, but I am assuming this benefit would not be there with a frozen embryo transfer as it would then be two months after?

[DrMichaelHartman]

The biopsy has nothing to do with the protocol, it can be done with any protocol. Usually it is done before starting the stimulation. It is the same as scratching done with other protocols, which is mostly done if your RE feels that it would be beneficial to implantation (there is not a consensus about this).

 

Typically, whether with fresh or frozen transfers, if your RE feels that scratching would be of benefit for you then it would be done the cycle preceding the IVF procedures. I am uncertain of any evidence of benefit lasting 2 months after in the case of a frozen transfer.

 

Best of luck